S3. THE ADVERSE EFFECT OF 10 ANTIPSYCHOTICS IN THE TREATMENT OF SCHIZOPHRENIA ON GLUCOSE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PLACEBO-CONTROLLED TRIALS

Abstract

Background People with schizophrenia have 2–3 times higher mortality rates than the general population [1–3], which corresponds to a mortality gap of 10 to 20 years [4]. At least 60% of this premature mortality is due to cardiovascular diseases [5]. Diabetes mellitus, which is a significant risk factor of cardiovascular diseases, is a group of metabolic diseases in which a person has high blood glucose that is characterized by chronic hyperglycemia. Second-generation antipsychotics (SGAs) have been extensively recommended as first-line agents for the treatment of schizophrenia. However, several studies have reported the presence of serious adverse effects on glucose metabolism during treatment with SGAs [6–10]. However, the comparative influence of antipsychotics on blood glucose levels has not been comprehensively evaluated. We conducted a systematic review and meta-analysis to evaluate the adverse effects of 10 antipsychotics on changes in blood glucose levels. Methods A systematic literature searches of the PubMed, EMBASE, Scopus, and Cochrane databases (last search Oct 2018) was conducted to identify studies that reported randomized placebo-controlled trials (RCTs) comparing changes in blood glucose levels between patients receiving antipsychotic or a placebo for the treatment of schizophrenia or related disorders. The primary outcome of interest was mean changes from baseline in fasting glucose levels. Results We included 29 studies reporting changes in fasting glucose levels. Of the 10 antipsychotics, only olanzapine was associated with significantly increased total fasting glucose compared to a placebo (standardized mean difference (SMD) = 0.192, 95% confidence interval (CI) = 0.002 to 0.382, p = 0.048). Discussion Olanzapine was associated with a significantly greater change in blood glucose levels than placebo treatment. The comparative influence of glucose metabolism-related side effects may help clinicians tailor the choice of antipsychotic drug to meet the needs of individual patients. References: 1. Osborn DP, Levy G, Nazareth I, Petersen I, Islam A, King MB. Arch Gen Psychiatry. 2007;64(2):242–9. 2. Saha S, Chant D, McGrath J. Arch Gen Psychiatry. 2007;64(10):1123–31. 3. Reininghaus U, Dutta R, Dazzan P, Doody GA, Fearon P, Lappin J, Heslin M, Onyejiaka A, Donoghue K, Lomas B, et al. Schizophr Bull. 2015;41(3):664–73. 4. Lawrence D, Hancock KJ, Kisely S. BMJ. 2013;346:f2539. 5. Ösby U, Correia N, Brandt L, Ekbom A, Sparén P. Schizophr Res. 2000; 45(1–2):21–8. 6. Melkersson KI, Hulting AL, Brismar KE. J Clin Psychiatry. 2000;61(10):742–9. 7. Melkersson KI, Hulting AL. Psychopharmacology. 2001;154(2):205–12. 8. Wirshing DA, Boyd JA, Meng LR, Ballon JS, Marder SR, Wirshing WC. J Clin Psychiatry. 2002;63(10):856–65. 9. Newcomer JW. J Clin Psychiatry. 2004;65(Suppl 18):36–46. 10. Ebenbichler CF, Laimer M, Eder U, Mangweth B, Weiss E, Hofer A, Hummer M, Kemmler G, Lechleitner M, Patsch JR, et al. J Clin Psychiatry. 2003;64(12):1436–9.